RTW Strategies: Washington’s COHE Model

What would it take to adopt/adapt key components of the COHE model to address your state’s workers’ compensation program challenges? (Please consider the required policy changes, the key players that would need to be convinced, and the supports, resources or materials that would help address their concerns and overcome barriers.)

Maybe there needs to be as in my case a facility that deals in radioactivity (a radio station) that maybe the facility should have an onsite doctor or doctor in the plan of the company wc package--that would bring down a cost to not only the business but could make sure that the employees dont have to worry about cost or health benefits--if all businesses did that then maybe that would just leave programs like medicaid
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Create a "Common Language" Resource or Interface for patients, providers, and insurance companies.
In a sense, patients are not in a position to be their own advocates, and need to be. Sometimes the reason a patient is not his/her own advocate is because they are in pain or unconscious. But I find that even when patients are coherent, they simply are not trained in the process of, or language of, the special jargon
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As the Medical Director of one of the 6 Washington State COHE's and as an occupational medicine clinician, I can state that in order for other states or the Federal government to implement a COHE-type model, there must be practicing physician leadership or involvement at every stage of development and implementation. By "practicing" I mean physicians who have at least 5 years of experience in serving as the attending
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If the existing healthcare delivery system is not delivering what the public policy people think is needed, the states can call new infrastructure into being that will deliver it: by paying for its development, and assuring an on-going stream of revenue afterwards to sustain it.
The states of Washington and Ohio have both created new healthcare system infrastructure to deliver specific kinds of services in order to
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If RTW vendors are being used to help injured workers return to work, much needs to be investigated as to the vendor's processes and procedures. To truly help injured workers find jobs, the vendor needs to do more in terms of job sourcing and advocacy FOR the claimant. Too often, not enough is done in terms of actual job placement strategies that leaves claims hanging and RTW ending up not being a success.
If a worker
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I have a knowledge of Workers Compensation from the Providers view. What I heard many injured workers say was they were afraid that getting hurt on the job would cause them to lose their job. From my experience, the insurance companies just see $ signs and push for the return to work. The employers fear that their premiums will go up and push for the return to work and the one who takes the brunt of all of that is the
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I am a former vocational rehabilitation counselor with experience in public and private rehabilitation settings on return to work topics. One of the biggest challenges we had was community transportation. For many of the individuals I worked with, they were no longer able to drive and/or financial issues necessitated them to give up their personal auto. Lack of transportation options was a critical determinant to reentry
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A key step in convincing key stakeholders to consider adopting/adapting COHE strategies would be to provide evidence of improvements in quality, cost savings, and return to work outcomes. For example, the Washington State labor agency estimates a savings of $3,175 per claim and 20% fewer days away from work for workers served by COHE providers compared to non-COHE providers. http://www.lni.wa.gov/Main/AboutLNI/Legislature/PDFs/Reports/2016/ImpMPNexpCOHE.pdf
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Modified work programs provide injured employees with light duty or more manageable tasks to facilitate early return to work. The duties are gradually scaled up to normal levels. These programs can cut in half work loss days, as well as significantly increasing the proportion of employees who return to work. However, modified work programs are not easy to implement. Successful implementation includes employer knowledge
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A key to the COHE approach is providers’ use of effective occupational health practices. Engaging providers in the return-to-work process requires creating a compelling case for change. This can be focused on making themselves attractive to payers, it can focus on adopting medical practice guidelines they need to follow, in can even involve provider incentives. A key is educating medical providers on their role in return
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Reducing lost work days can be a significant benefit for employers. Getting buy-in from employers can provide important leverage with insurers. Employers are motivated to purchase their WC insurance from payers who will hold providers accountable for rapid return to work.

Transition Back to Work

Providing light duty or part-time work, and partial disability payments during the transition back to work, can encourage workers to return earlier, minimizing the likelihood they will drop out of the workforce.

It can be a huge loss to lose an employee and it may become necessary to reassign duties to other workers or even bring in a replacement. Offering employers wage subsidies for workers or for accommodations is a promising strategy for facilitating return-to-work.

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Washington COHE Model

What would it take to adopt/adapt key components of the COHE model to address your state’s workers’ compensation program challenges? (Please consider the required policy changes, the key players that would need to be convinced, and the supports, resources or materials that would help address their concerns and overcome barriers.)